The Cost of a Medicaid Mistake

We took a little detour but this is the conclusion of my previous post on some of the more common Medicaid mistakes I see people without a Woodlands Medicaid attorney make. What is the cost of making one or more mistakes during the nursing home Medicaid eligibility process? Well, the cost to you and your parent or spouse is going to depend on the kind of mistake(s) you make.

The way I look at it there are two categories of mistakes. The first category is a mistake of documentation or other evidence. These kinds of mistakes are not providing the HHSC with some documentation they require in order to review the Medicaid application. As long as you fix these mistakes before the HHSC issues their ruling on the application the cost is generally not that high (unless the extra delay caused by the mistake leads to increased threats from the nursing home). If you do not fix these kinds of mistakes while the application is still open with the HHSC then you risk turning a documentation mistake into the second category of mistake which is a lot more costly.

The second category is a mistake in eligibility status. These kinds of mistakes include (among many other items) being over the income limit, being over the asset limit and having a Medicaid penalty for gifts or transfers in the last 5 years. If you make these mistakes then there is no Medicaid eligibility until after the mistake is fixed, you cannot retroactively fix these kinds of mistakes. If your parent or spouse was over the asset limit for the month of April they will always be over the asset limit for the month of April, there is nothing you or I can do after 12:01am on April 1 to change that. I can fix it for May if you see me early enough, but I cannot change April after the month has begun. Let’s look at an example.

Let’s say your parent is in a nursing home and their money ran out in February so you applied for Medicaid beginning on March 1st. So now you wait to hear from the HHSC which might take 30 days or more. They get back to you shortly after April 1st with a denial based on one of the mistakes described above. Let’s say your parent’s assets were $2,100 on March 1 or their gross monthly income was $2,200 per month. So now the financial cost of these mistakes is likely up to 2 months of nursing home bills because you won’t get Medicaid for March and you might be ineligible for April also. We are up to about $10,000 based on average nursing home costs. For every month you do not fix your mistakes tack on another month of nursing home bills of about $5,000 or more.

On top of the financial costs you also risk some severe non-financial costs. These are nursing home eviction and responsible party lawsuits. I’ve discussed earlier these issues in more detail previously so feel free to take a look at those articles for more information.

As you can see, some mistakes in the Medicaid eligibility process can be very costly for you and your parent or spouse not only in terms of financial cost but also in terms of unnecessary emotional distress during an already difficult time. Accidents cannot be avoided but mistakes can. If you need help getting through the Medicaid eligibility process without any unexpected surprises then contact me to get started. I am The Woodlands Medicaid Attorney here to help you pay for the nursing home without going broke and I help families just like yours throughout all of Texas.